Childhood Lead Poisoning Research Articles

Environmental illness: educational needs of pediatric care providers

ABSTRACTBackground Assessing the impact of children's exposures to environmental toxins is an emerging new subspecialty in clinical pediatrics. However, pediatric health professionals in practice may not be familiar with critical information necessary to diagnose and manage environmental toxic exposures in children.Objective The objective of this study was to investigate the perceptions of pediatricians, nurses, and nurse practitioners regarding their own practices and educational needs concerning pediatric environmental exposures.Methods Health professionals attending a general pediatric postgraduate course were administered a 22‐item questionnaire on their practices and educational needs in children's environmental health.Results A total of 93% of participants returned usable questionnaires. Within the previous 6 months, over 90% of pediatricians and nurse practitioners had diagnosed food poisoning; almost 50% had diagnosed lead poisoning; 50% had diagnosed a child's illness as due to exposure to a toxic chemical; and 24% had diagnosed ‘building‐related illness.’ Although 90% of pediatricians and 82% of nurses and nurse practitioners stated that they routinely asked families about parental occupations, only 35% of both groups asked about parental hobbies. Only 58% of the groups asked about smoke detectors in the home, and only 18% of nurses and 9% of pediatricians queried families about their use of radon detectors. Over 70% of all three groups indicated a high interest level in the following postgraduate educational topics: taking in environmental history, breast milk contaminants, food allergies, food contamination, and illness related to tobacco smoke. Topics that did not garner as high an interest level included: childhood lead poisoning, radon poisoning, and building‐related illness.Conclusion Pediatric health professionals commonly diagnose environment‐related illnesses, and they include such topics during well child care. They indicate a variety of educational needs concerning pediatric environmental health issues.Implications for practice Health care professionals are increasingly asked by parents to include environmental toxins among the possible causes of a child's ill health. Our results suggest that clinicians recognize their own need for further training in the principles of pediatric environmental health. Further research is needed in determining which modalities are best suited to achieve such educational objectives.

Twin Tragedies in the Twin Cities: Childhood Lead Poisoning and the Loss of Affordable Rental Housing

The purpose of this study was to determine the impact that the Minnesota lead policy had on affordable rental housing in Minneapolis and St. Paul. Questionnaires were sent to 487 owners of property in those cities who were issued lead orders in 1994 or 1995; 147 questionnaires were returned. There was a significant difference in the implementation of the state policy by the two cities. Lead orders written by the City of Minneapolis required more work, more complex work, and higher costs than did the lead orders written by the City of St. Paul. Orders issued by St. Paul were more in line with hazard reduction (lead‐safe) activities, whereas those issued by Minneapolis were more in line with abatement (lead‐free) activities. In Minneapolis, there was a significantly greater loss of affordable housing units through abandonment by the property owner, condemnation by the city, increased vacancy periods, and changes in the affordability level.

The road to primary prevention of lead toxicity in children.

The clinical recognition of lead toxicity in children in the United States has changed drastically over the past 50 years. Accordingly, both medical management and public policy in such cases needs to be modernized in keeping with these changes. Fifty years ago lead poisoning in children was often only recognized in the severe acute phase (acute lead encephalopathy). Today this condition is rare, and children are detected in screening programs most often in the asymptomatic phase. The removal of lead additives from gasoline and the removal of lead solder from food and beverage cans has greatly reduced the background level of lead absorption during the past decade.1 The changes in exposure to lead and its clinical presentation mandate that we change the approach to the management of childhood lead toxicity. We must place reduced emphasis on chelation therapy and major emphasis on the environmental history to identify the source(s) of lead in the child's environment and steps to separate the child from these sources. The primary source of lead in childhood lead toxicity 50 years ago was deteriorating lead paint in old housing: it remains the primary source in the United States today. Reduction of exposure is the single most important modality of long-term management, as it has been for >50 years. When chelating agents first appeared—2,3-dimercapto-1-propanol (BAL)2 in 1946 and calcium disodium ethylenediaminetetraacetate (CaNa2EDTA)3 in 1950—childhood lead poisoning was recognized clinically only in the severe acute phase. These agents alone reduced the mortality of severe acute lead encephalopathy from 66% to approximately 25% to 30%.4Subsequently, it was found that these agents given in combination5 reduced mortality to about 1% to 2%. They were not effective in reducing the neurologic sequelae.6Ongoing prospective studies conducted now to at least 10½ years …

Childhood Lead Poisoning and Affordable Rental Housing: An Analysis of the Implementation of the Minnesota Lead Policy in Minneapolis and St. Paul, 1991-1995

Childhood lead poisoning remains a serious public health concern in the United States today. had-based paint in pre-1978 housing stock is the major source of exposure. Although theprimary objective of lead regulation is to reduce the incidence of childhood lead poisoning, i7ller (1994) suggested that lead legislation has not signzjicantly met that objective, primarily due to poor procedures for implementation. In addition, federal, state, and local regulations that are intended to achieve these goals may turn out to have negative consequences for affordable housing because the impact on housing costs may not have been considered when the regulations were first promulgated (ACRBAH, 1991).The purpose of this study was to analyze the implementation of the Minnesota lead statute by the cities of Minneapolis and St. Paulfrorn 1991-1995, which represented the time from when the statute went into effect (1991) to when major revisions were made (1995). The case study approach provided qualitative answers to the questions: “How did the 1991 Minnesota lead statute structure implementation?”; “What components of implementation were lefr up to local discretion?”; and “What impact did implementation have on affordable rental housing?” Sabatier and Mavnanian’s (1980) conceptual framework of the policy implementation process was used to develop an interview guideline, and as the survey instrument for in-person interviews with current and past lead oficials.The findings showed that the Minnesota lead statute was loosely structured, allowing enough discretion by local administering agencies for differential implementation of the policy by the mo cities, particularly in the writing of lead orders. The lead oficials reported that the impact of the implementation of the statute on affordable housing was real, unintended, and largely negative. Aflordable housing units were removedfrom the current housing stock through increased vacancy periods, abandonment by the property owner, and condemnation by the city. In addition, both homelessness and discrimination against families with children were reportedly increased

A community-developed, community-based lead poisoning prevention program: Lead Awareness North Philly Style.

This work describes a demonstration/research project to implement and evaluate community-developed, community-based strategies that address childhood lead poisoning. The project will increase knowledge of childhood lead poisoning as an environmental health risk, as well as hazard, exposure, and outcome surveillance for lead as an environmental agent. At the end of the second year of this study the data indicate increased knowledge about lead poisoning and that more children are being tested for lead poisoning in the experimental census tracts (CTs), when compared with the control CTs, with lower lead levels.

The presence of lead decreases the availability of meso-2, 3-dimercaptosuccinic acid for analysis in the monobromobimane assay.

meso-2,3-Dimercaptosuccinic acid is a suitable chelating agent for routine pharmacotherapy of lead poisoning in children. Administration of meso-2,3-dimercaptosuccinic acid presumably permits complexation of lead in vivo, allowing excretion through urine or feces. Quantification of the lead is achieved independently from the analysis of meso-2,3-dimercaptosuccinic acid and metabolites from the monobromobimane assay. To date, no direct chemical characterization of the Pb species excreted in urine has been successful. Pharmacokinetic correlation of lead excretion with excretion of meso-2,3-dimercaptosuccinic acid and metabolites has been utilized as an indirect method to draw conclusions regarding the identity of the active chelating agent. In this study, we hypothesized that the Pb-coordinated thiols are not reactive with respect to monobromobimane, and thus, the active chelator contained in the lead complex escapes detection. We performed variations of the assay and found that (1) the fluorescence detector response for the meso-2,3-dimercaptosuccinic acid-monobromobimane adduct was clearly attenuated as a function of added Pb, (2) when meso-2, 3-dimercaptosuccinic acid and monobromobimane were mixed prior to the addition of lead, the lead had no effect on detector response, (3) the addition of dithiothreitol does not affect the ability of Pb to react with meso-2,3-dimercaptosuccinic acid and verifies that oxidation of meso-DMSA had not occurred, and (4) the addition of ethylenediaminetetraacetic acid to the assay reverses the result found in point 1, presumably through trans chelation of the Pb-DMSA complex. Indirect quantification of the Pb-DMSA complexes found in urine might be accomplished through modification of the standard monobromobimane assay for analysis of meso-2,3-dimercaptosuccinic acid.

CHILDHOOD LEAD POISONING PREVENTION

CHILDHOOD LEAD POISONING PREVENTION The Editors Comment Theodore M. Brown, and Elizabeth Fee CopyRight https://doi.org/10.2105/AJPH.89.7.1131 Published Online: October 07, 2011

Le saturnisme chronique chez l'enfant aujourd'hui. Une pathologie de la pauvreté et de l'exclusion

Despite the recognition of lead poisoning in children as a major public health problem in France since the 1980's, the setting-up of systematic detection of lead poisoning at a national level has not yet been done. The main source of intoxication in children is in paintings containing ceruse in housing built before 1948. Moderate chronic poisoning, although leading to irreversible lesions, particularly of the central nervous system, remains usually unnoticed. The biological diagnosis is mainly based upon blood lead level, completed by the protoporphyrine-zinc level. Large scale identification of dangerous housing and the control of rehabilitation are the only means available to decrease the incidence of lead posioning. Targeted screening is difficult because it concerns children excluded from classical health care systems. Prevention and long-term treatment requires elimination of the source of lead intoxication after an environmental inquiry. This raises the problems of rehousing and follow-up of intoxicated children.

Maternal perceptions of lead poisoning in children with normal and elevated lead levels

Introduction: The purpose of this study was to examine mothers' perceptions of the severity and susceptibility of their children to lead poisoning and to determine if a correlation existed between mothers' knowledge of lead poisoning and their children's blood lead levels. It was thought that mothers of children with lead poisoning (lead levels ≥10 μg/dL) would score lower on a test of their perceptions and knowledge of lead poisoning than would mothers of children with normal lead levels (lead levels ≤9 μg/dL).Method: A cross-sectional study comparing scores of a questionnaire completed by mothers whose children had elevated blood lead levels and mothers whose children had normal blood lead levels was conducted.Results: No difference was found in the median test score between the 2 groups. For the correct responses on a question-by-question comparison, significant differences existed between groups; however, the percentage of correct responses was not always greater for the mothers of children with normal blood lead levels.Discussion: Mothers' perceptions and knowledge of lead poisoning were not associated with their children's blood lead levels.

Lead Hot Zones and Childhood Lead Poisoning Cases, Santa Clara County, California, 1995

Lead Hot Zones and Childhood Lead Poisoning Cases, Santa Clara County, California, 1995

Development of Childhood Blood Lead Screening Guidelines, Duval County, Florida, 1998

Christopher Duclos, MS,is an Environmental Specialist 1, at the Bureau of Environmental Epidemiology, Florida Department of Health in Tallahassee, Florida. Tammie Johnson, BS,is a Health Services and Facilities Consultant at the Bureau of Environmental Epidemiology, Florida Department of Health in Tallahassee, Florida. Trina Thompson, MA,is Program Coordinator for the Childhood Lead Poisoning Surveillance Program at the Bureau of Environmental Epidemiology, Florida Department of Health in Tallahassee, Florida.

Lead Hot Zones and Childhood Lead Poisoning Cases, Santa Clara County, California, 1995

Wilkinson, Su-Lin; Gobalet, Jeanne G.; Majoros, Marcia; Zebrowski, Bernie; Olivas, Guadalupe S. Author Information

Childhood lead poisoning: the promise and abandonment of primary prevention.

In 1991, the Public Health Service published the Strategic Plan for the Elimination of Childhood Lead Poisoning. This document marked a fundamental shift in federal policy from finding and treating lead-poisoned children to authentic primary prevention. It spelled out a 15-year strategy to achieve this goal and provided a cost-benefit analysis showing that the monetized benefits far exceeded the costs of abatement. A strong national effort to eliminate the disease developed. Now, 7 years after publication of the plan, primary prevention of lead exposure has been abandoned. This article examines the role of some prevailing attitudes and institutions in derailing the effort. Some institutions--the lead industry, real estate interests, and insurance interests--behaved as anticipated. Others, including private pediatricians, the American Academy of Pediatrics, some federal agencies, and a public interest group ostensibly dedicated to eliminating lead poisoning, also played an unexpected part in derailing the plan.

What do parents know about lead poisoning? The Chicago Lead Knowledge Test. Pediatric Practice Research Group.

To examine the extent of parental knowledge about lead poisoning and its prevention and to determine characteristics associated with accurate lead knowledge. Twenty-three pediatric practices and 1 family practice in Chicago, Ill, and its suburbs. A 24-question test regarding lead poisoning and its prevention (Chicago Lead Knowledge Test) was developed based on lead specialists' review and parental test-retest reliability. One point was assigned for each correct response. It was self-administered by a sample of 2225 parents of 0- to 6-year-old children visiting study practices. A 1-way analysis of variance (ANOVA) was used to determine the association of demographic descriptors with test scores. Respondents had a mean age of 33 years. Ninety percent were mothers, 49% were college graduates, and 80% were home owners. Fifteen percent lived in homes built before 1950, of which 36% were remodeled or renovated during the last 6 months. Respondents' youngest children were 80% white, 10% Hispanic, 5% African American, and 5% other. Ten percent received Medicaid and 86% had other medical insurance. Thirty-four percent recalled receipt of lead information from a health care provider, and 2.4% had had a child with a blood lead level of 0.48 micromol/L (10 microg/dL) or higher. The mean Chicago Lead Knowledge Test score was 12.2 (SD, 3.7). Questions related to lead exposure were more often answered correctly than those related to prevention and diet. In the ANOVA model, those who recalled receipt of lead information from a health care provider, college graduates, respondents aged 30 years or older, Hispanic respondents, and those living in homes built before 1950 had higher scores (all ANOVA P< or =.001). Parents do not have much knowledge of ways to prevent childhood lead poisoning. Information from a health care provider can aid parental knowledge. The Chicago Lead Knowledge Test is a new self-administered tool to help evaluate lead education programs.

Lead poisoning of children in Africa, IV: Exposure to dust lead in primary schools in south-central Durban, South Africa

Twenty primary schools in three areas (Merebank, Austerville and Bluff) of south-central Durban, South Africa were studied to determine if dust lead loading (μg/m 2) is high enough to constitute a risk to children. Atmospheric lead fallout rates in the schools varied from 9 to 264 μg/m 2 per day and were higher than the values now being reported in the developed countries. Mean outside dust lead loadings were 425 μg/m 2 in Merebank, 771 μg/m 2 in Austerville and 1174 μg/m 2 in Bluff areas, and 25% of the primary schools were found to have mean outside dust lead loading above 1000 μg/m 2. Mean dust lead loadings inside classrooms were 2–4 times lower than the outside rates, and showed no significant difference among schools in the three areas. Dust lead loadings were correlated with lead concentrations in dust but not with distance from the highway or with atmospheric lead deposition rates. Exposure to dust lead in classrooms and in the school yard is considered to be an important contributor to blood lead levels in, and hence a potential health hazard to, children in many urban areas of the city.

Laundry Dryer Lint: A Novel Matrix for Nonintrusive Environmental Lead Screening

North American health agencies have set ambitious goals to reduce childhood and occupational lead poisoning. A central tool in attaining lead exposure reduction objectives is screening populations to identify persons at risk. We have identified laundry dryer lint as a novel matrix with potential use as a nonintrusive, first stage screening mechanism for households with elevated lead levels. This Edmonton, AB, pilot study provides the first measures of lead levels in household laundry dryer lint. Three populations were included: a control group, a group using communal dryers at an inner city service agency (Bissell Centre), and households where a family member had occupational exposure to lead. Background levels of lead in laundry dryer lint from a Canadian urban environment were established, households with elevated lead levels resulting from the transport of occupational lead by an adult family member were identified, and scanning electron microscopy was used to identify the form of the lead particles and determine their source.

Linking research and policy to ensure children's environmental health.

The U.S. Environmental Protection Agency (U.S. EPA) has made protecting children's environmental health its highest priority. Data on how and when children may be at risk are vital for accomplishing this goal. Recent examples of the link between research and policy include U.S. EPA actions to carry out the recommendations of the National Academy of Sciences on pesticides in children's food, reduce and prevent childhood lead poisoning, and revise national ambient air quality standards for ozone and particulate matter. Today, the Food Quality Protection Act (FQPA), which makes protecting children from pesticide residues in food a national priority, is contributing to the growing need for data for decision making. Further impetus comes from provisions in the FQPA and 1996 Safe Drinking Water Act Amendments for establishing a screening and testing program for potential risks from endocrine disruptors. Another factor is the analysis that will be required under President William J. Clinton's executive order directing all federal agencies, for the first time, to reduce environmental health and safety risks to children. Success of the U.S. international commitment to protect children is directly tied to the strength and availability of environmental data. To meet such challenges, the U.S. EPA is revising key science policies, expanding research opportunities, and adding to the public's right-to-know tools. In this dynamic climate, there are growing opportunities for the research community to play a greater role in helping ensure the well-being of children living today and in generations to come.

Erratum: A Tale of Two Counties: Childhood Lead Poisoning, Industrialization, and Abatement in New England

Erratum: A Tale of Two Counties: Childhood Lead Poisoning, Industrialization, and Abatement in New England

Preventing Childhood Lead Poisoning:: The Challenge of Change

Because of their rapid growth, immature biologic systems, and their developmental characteristics, children are uniquely vulnerable to exposure to environmental hazards. One of these is lead. Revised lead screening guidelines, published by the Centers for Disease Control and Prevention in Fall 1997, no longer advocate universal screening in some places. These guidelines will (1) require new policies from local public health agencies, (2) require new approaches for clinicians and managed care organizations, especially those with Medicaid-recipient enrollees, to conduct screening of children who may be at risk for exposure to lead, (3) offer new challenges for environmental follow-up to children identified with elevated lead levels, and (4) provide opportunities for collaboration between managed care and public health agencies.

A Tale of Two Counties: Childhood Lead Poisoning, Industrialization, and Abatement in New England

We examine spatial variation in childhood lead poisoning within two industrial counties in New England: Worcester County, Massachusetts, and Providence County, Rhode Island. The findings suggest that lead exposure is linked to the differential patterns of urbanization and industrial activity and that a history of abatement can reduce lead exposure. Lead exposure in census tracts with minority neighborhoods varies in complex ways between the counties. We conclude that attention to local context forms an essential component of understanding how public health interventions will continue to affect the geography of childhood lead poisoning.